A Bad Case of Acne?

A Bad Case of Acne?

A 26-year-old African American woman was concerned about the gradual onset of mildly tender, but severely distressing facial lesions. She had not sought medical attention previously because of a lack of insurance and assurances by her mother that this was only “bad acne.” Use of a popular over-the-counter benzoyl peroxide–based acne kit brought no improvement, however.

What features would lead you to rule acne in—or out—and what other diagnoses would you consider?